JP4361859B2 - Full thickness ablation device - Google Patents

Full thickness ablation device Download PDF

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JP4361859B2
JP4361859B2 JP2004506666A JP2004506666A JP4361859B2 JP 4361859 B2 JP4361859 B2 JP 4361859B2 JP 2004506666 A JP2004506666 A JP 2004506666A JP 2004506666 A JP2004506666 A JP 2004506666A JP 4361859 B2 JP4361859 B2 JP 4361859B2
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tissue
tissue stapling
cable
shaft
head assembly
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JP2005526568A (en
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ケー シャルマ サティシュ
アイ フリード デビッド
パトロニク ニコラス
エム ウェンドランド ジェフリー
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Boston Scientific Ltd Barbados
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00353—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery one mechanical instrument performing multiple functions, e.g. cutting and grasping
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07221—Stapler heads curved
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2901—Details of shaft
    • A61B2017/2905—Details of shaft flexible

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Dental Preparations (AREA)

Abstract

A full thickness resection device comprises a control handle including an actuator wherein, when the device is in an operative position within a body lumen of a patient, the control handle remains outside the patient's body and a working head assembly coupled to a control handle by a flexible sheath, wherein, when the device is in the operative position; the working head assembly is located within a body lumen of the patient adjacent to a portion of tissue to be treated, the working head assembly including a tissue stapling mechanism including first and second tissue stapling members moveable relative to one another in combination with a first cable extending from the actuator through the flexible sheath to the first tissue stapling member so that, when the actuator is operated to draw the first cable proximally from the sheath, the first tissue stapling member is moved in a first direction relative to the second tissue stapling member.

Description

全層切除処置には、臓器の一部の全層を摘出すること、摘出によってできた穴を塞ぐこと、余分な組織を除去することを伴う。   A full-thickness resection procedure involves removing a full thickness of part of an organ, closing a hole created by the removal, and removing excess tissue.

様々な既存の全層切除装置及び処置は、内科医が臓器部位へアクセスし、装置を導くことを可能とするために、切除する臓器の近くで少なくとも一度、切開を要する。当業者は、切除処置に伴うこの切開が実質的に患者に不快感を与え、回復する時間を更に要することを理解する。   Various existing full thickness ablation devices and procedures require an incision at least once near the organ to be excised to allow the physician to access the organ site and guide the device. Those skilled in the art will appreciate that this incision associated with the ablation procedure is substantially uncomfortable for the patient and requires more time to recover.

（発明の要約）
本発明は、作動装置を含む制御ハンドルからなる全層切除装置であり、該装置が患者のボディ・ルーメン内で作動位置にある時、制御ハンドルは患者の体外にありワーキング・ヘッド・アセンブリは柔軟な覆いで制御ハンドルに接続され、装置が作動位置にある時、ワーキング・ヘッド・アセンブリは、治療される組織部位に隣接する患者のボディ・ルーメン内に配され、覆いを介して作動装置から第１組織ステープリング部材へ延長される第１トランスミッション部材と関連して互いに移動可能である第１及び第２組織ステープリング部材を含み、組織ステープリング装置を含むワーキング・ヘッド・アセンブリは、トランスミッション部材が操作される時、第１組織ステープリング部材が第２組織ステープリング部材に関連して第１方向へ移動する。 (Summary of the Invention)
The present invention is a full-thickness ablation device comprising a control handle including an actuating device, wherein the control handle is outside the patient's body and the working head assembly is flexible when the device is in the actuated position within the patient's body lumen. When the device is in the operative position with a protective covering and the device is in the activated position, the working head assembly is disposed within the patient's body lumen adjacent to the tissue site to be treated, and is connected to the actuator through the covering. A working head assembly including first and second tissue stapling members movable relative to each other in relation to a first transmission member extended to a tissue stapling member, wherein the transmission member includes When operated, the first tissue stapling member is in a first direction relative to the second tissue stapling member. Moving.

本発明は、２０００年１０月２５日に出願された、発明の名称が「Method and Device for Full Thickness Resectioning of an Organ」である米国特許出願第０９／６９４,８９４号と実質的に類似する多くの特徴を含むボディ・ルーメンの組織の全層切除のためのシステムからなり、前記特許は本明細書中「８９４出願」の表記で、参照として組み入れられる。
当業者は、下記のワーキング・ヘッド・アセンブリ２が、以下で特に詳細に記載する特徴を除いて「８９４出願」に記載される実施形態と実質的に一致して構成されることを理解する。
以下記載される各実施形態は、組織ステープリング器具の駆動装置を囲むために必要とされるワーキング・ヘッド・アセンブリの長さを縮小する。 The present invention is substantially similar to US patent application Ser. No. 09 / 694,894, filed Oct. 25, 2000, whose title is “Method and Device for Full Thickness Resectioning of an Organ”. A system for full-thickness resection of body lumen tissue, including the following features: the patent is hereby incorporated by reference under the designation “894 Application”.
Those skilled in the art will appreciate that the following working head assembly 2 is configured substantially in accordance with the embodiment described in the “894 Application” except for the features described in greater detail below.
Each of the embodiments described below reduces the length of the working head assembly required to enclose the drive device of the tissue stapling instrument.

図１から図３に示されるように、本発明の第１実施形態の器具は、ワーキング・ヘッド・アセンブリ２からなり、該ワーキング・ヘッド・アセンブリは好ましくは覆い４の遠端４ａに接続される。覆い４の近端４ｂは、好ましくは、手術の間患者の体外にある制御ハンドル６に接続される。   As shown in FIGS. 1 to 3, the instrument of the first embodiment of the present invention comprises a working head assembly 2, which is preferably connected to the distal end 4 a of the cover 4. . The proximal end 4b of the cover 4 is preferably connected to a control handle 6 that is outside the patient's body during surgery.

手術中、図１及び図２に示すように装置全体は、制御ハンドル６、覆い４を通る内視鏡８を通すことで該内視鏡に取り付けられ、ワーキング・ヘッド・アセンブリ２において、該内視鏡は通路９を通る。
次に内視鏡８は、臓器の病斑を目視観測するように位置するために、ボディ・オリフィスを介して臓器に挿入される（通常は臓器を吸入する）。臓器は、例えば実質的に大腸のような管状の組織であることもある。一度病斑の位置を確認したならば、ワーキング・ヘッド・アセンブリ２及び覆い４は、病斑に隣接する望ましい場所に位置するまで、臓器内を内視鏡８に沿ってスライド可能なように前進する。
当業者は本発明の装置はまた、外科処置で作られる開口部を介してボディ・ルーメンに挿入することが可能である事を理解する。 During the operation, as shown in FIGS. 1 and 2, the entire device is attached to the endoscope by passing the endoscope 8 through the control handle 6 and the cover 4, and the working head assembly 2 The endoscope passes through the passage 9.
Next, the endoscope 8 is inserted into the organ through the body orifice (usually inhaling the organ) in order to be positioned so as to visually observe the lesion of the organ. The organ may be a tubular tissue, such as a substantially large intestine. Once the location of the lesion is confirmed, the working head assembly 2 and the cover 4 are slidably moved along the endoscope 8 in the organ until it is located at a desired location adjacent to the lesion. To do.
Those skilled in the art will appreciate that the device of the present invention can also be inserted into the body lumen through an opening made in a surgical procedure.

図２に示される通り、ワーキング・ヘッド・アセンブリ２は、ハウジングの近端１２ｂに接続される近接カップ１４と共に、ハウジング１２の遠端１２ａに接続される台部材１０からなる。ステープル発射装置１６は、遠端１２ａに取り付けられ、該発射装置から発射されるステープルは、台部材１０に近い側面でステープル成形面１０ａに導かれる。
当業者は、いくつものワーキング・ヘッド・アセンブリ及び台の形状は、特定の適用のために組織のステープリング及び切断に望ましい形状に合せて採用することができることを理解する。 As shown in FIG. 2, the working head assembly 2 comprises a base member 10 connected to the distal end 12a of the housing 12 with a proximity cup 14 connected to the proximal end 12b of the housing. The staple firing device 16 is attached to the distal end 12 a, and the staples fired from the firing device are guided to the staple forming surface 10 a on the side surface close to the base member 10.
Those skilled in the art will appreciate that any number of working head assemblies and platform shapes can be employed to suit the desired shape for tissue stapling and cutting for a particular application.

駆動装置（以下、より詳細に記載される）は、所定の組織を受け入れる距離で、台部材１０が遠端１２ａから分離される第１位置と、該組織を受け入れる距離よりも短い、望ましいステープリング距離で台部材１０が遠端１２ａから分離される第２位置の間を、ステープル発射装置１６と関連して台部材１０を移動する。
当業者は、装置のボディ・ルーメンへの挿入及び該装置のボディ・ルーメンからの撤収のために、駆動装置は、遠端１２ａに関連して台部材１０を完全に閉止する位置まで移動することが可能であり、該台部材１０に近い側面は、遠端１２ａと接触することを理解する。
本発明の駆動装置は、ワーキング・ヘッド・アセンブリ２の軸長を縮小することが可能であり、従って装置の可動性を改良し、より大きな、可動性が小さいＦＴＲＤ装置では届かない領域で装置を利用する事を可能とする。 The drive device (described in more detail below) is a desired stapling that is less than a first position where the platform member 10 is separated from the distal end 12a at a distance to receive a predetermined tissue and a distance to receive the tissue. The table member 10 is moved in relation to the staple firing device 16 between a second position at which the table member 10 is separated from the far end 12a.
Those skilled in the art will recognize that the drive moves to a position that fully closes the platform member 10 relative to the distal end 12a for insertion into and removal from the body lumen of the device. It is understood that the side surface close to the base member 10 contacts the far end 12a.
The drive device of the present invention is capable of reducing the axial length of the working head assembly 2, thus improving the mobility of the device and allowing the device to be reached in areas not reachable by larger, less mobile FTRD devices. It can be used.

特に図２で示される通り、台部材１０が組織を受け入れる位置にある時、操作者が病斑を切除のために引き出すことを可能とする、十分に大きな隙間により、台部材１０は遠端１２ａから分離される。切除される組織が台部材１０と遠端１２ａの間の隙間の方に引き出される時、操作者は台部材１０を望むステープリング位置へ移動するために駆動装置を作動させ、隙間により台部材１０は遠端１２ａから分離され、該隙間の大きさは用いられるステープルの特徴に基づいて選択され、ステープルは操作者の望ましい形状に形成される。
従って、当業者は隙間の大きさが特定の適用に応じて変化し、装置は既存のステープル調整装置を利用する操作者により設計、又は調整が可能であることを理解する。図３ａ、図３ｂに示される他の実施形態において、最小の隙間の大きさは、ショルダー部材１２ｃで制御され、該ショルダー部材は遠端１２ａから離れて突出する。
従って、台部材１０が接近すると、表面１０ａを形成するステープルと遠端１２ａの間隔が望ましいステープリング間隔の時、該台部材の近接面はショルダー部材１２ｃと接触する。この場合、ステープリング位置は完全に閉止した位置と同じである。 In particular, as shown in FIG. 2, when the pedestal member 10 is in a position to receive tissue, the pedestal member 10 has a far end 12a due to a sufficiently large gap that allows the operator to withdraw the lesion for excision. Separated from. When the tissue to be excised is pulled toward the gap between the platform member 10 and the distal end 12a, the operator operates the drive device to move the platform member 10 to the desired stapling position, and the platform member 10 is driven by the gap. Is separated from the distal end 12a, and the size of the gap is selected based on the characteristics of the staple used, and the staple is formed into the desired shape of the operator.
Accordingly, those skilled in the art will appreciate that the size of the gap will vary depending on the particular application, and that the device can be designed or adjusted by an operator utilizing an existing staple adjustment device. In another embodiment shown in FIGS. 3a and 3b, the minimum gap size is controlled by a shoulder member 12c that projects away from the far end 12a.
Accordingly, when the base member 10 approaches, the proximal surface of the base member comes into contact with the shoulder member 12c when the desired stapling interval is the distance between the staple forming the surface 10a and the far end 12a. In this case, the stapling position is the same as the fully closed position.

図２、図３ａ及び図３ｂに示されるように、第１実施形態の台部材１０は、２本の取付軸２８でハウジング１２に接続され、該取付軸は、対応する取付軸通路３０を通してスライド可能なように受け入れられる。
各軸２８は延長される中央通路３２を含み、その結果、圧縮スプリング３４が、隣接して対応する、各軸通路３０の近端に取り付けられるスプリング止め３６の内部に受け入れられる。各スプリング３４の遠端は、対応する中央通路３２の遠端で内面に隣接する。
従って、圧縮スプリング３４は台部材１０を、ハウジング１２の遠端１２ａから離れて一方に偏らせる。当業者は、中央通路３２及びスプリング３４の長さが、解放された時に台部材１０が、少なくとも望んだ組織を受け入れる隙間と等しい距離を、遠端からスプリング３４により離れて移動するように選択されることを理解する。
更に、図３ｃ及び図３ｄに示されるように、台部材１０が望んだ組織を受け入れる最大の隙間を越えて遠端１２ａから離れるのを防ぐため、ハウジング内でスプリング３４に対応する軸通路３０に向かって該スプリングに延びて対応する停止面４０に接触するために、隣接する表面３８を軸２８の一方又は両方に形成することができる。 As shown in FIGS. 2, 3 a and 3 b, the base member 10 of the first embodiment is connected to the housing 12 by two mounting shafts 28, and the mounting shafts slide through corresponding mounting shaft passages 30. Accepted as possible.
Each shaft 28 includes an extended central passage 32 so that a compression spring 34 is received within an adjacent, corresponding spring stop 36 attached to the proximal end of each shaft passage 30. The distal end of each spring 34 is adjacent to the inner surface at the distal end of the corresponding central passage 32.
Accordingly, the compression spring 34 biases the base member 10 away from the far end 12a of the housing 12 to one side. One skilled in the art will select the length of the central passage 32 and the spring 34 such that when released, the platform member 10 moves away from the distal end by the spring 34 a distance at least equal to the gap for receiving the desired tissue. I understand that.
Further, as shown in FIGS. 3c and 3d, in order to prevent the base member 10 from moving away from the distal end 12a beyond the maximum clearance for receiving the desired tissue, the shaft passage 30 corresponding to the spring 34 in the housing Adjacent surfaces 38 can be formed on one or both of the shafts 28 to extend toward the springs and contact the corresponding stop surfaces 40.

台制御ケーブル４２は、軸２８の最初の１本の遠端から延びてループ状に形成され、該ループは対応する軸通路３０及び中央通路３２を貫通し、制御ハンドル６へ、覆い４を離れて通過するために覆い４の近くへワーキング・ヘッド・アセンブリ２を貫通して接続される。
ケーブル４２のループは、軸２８の遠端に接続するために対応軸通路３０及び中央通路３２を介して、ワーキング・ヘッド・アセンブリ２へ覆い４とは逆向きに延長される。
具体的には、台制御ケーブル４２は台部材１０に接続される制御軸２８の各遠端に接続され、制御ハンドル６内の覆い４を貫通し、制御ケーブル作動装置（図示せず）を通るループとして通過する。
従って、制御ケーブル作動装置を作動することは、台制御ケーブル４２のループを近くに引き、スプリング３４の偏りに対する遠端１２ａに関連して台部材１０を近くに引き寄せる。当業者は代わりに台制御ケーブル４２のループが２本の分離したケーブル、又は同じ作動を行うための１本のケーブルとして形成されることを理解する。
更に当業者は望めば、台部材１０が１本の軸２８でハウジング１２に接続されることを理解する。しかしながら、そのような設計は剛性を減少することがある。 The pedestal control cable 42 extends from the first distal end of the shaft 28 and is formed in a loop that passes through the corresponding shaft passage 30 and central passage 32 and leaves the cover 4 to the control handle 6. Is connected through the working head assembly 2 close to the cover 4 for passing through.
The loop of the cable 42 is extended in the opposite direction to the cover 4 to the working head assembly 2 via the corresponding shaft passage 30 and the central passage 32 for connection to the far end of the shaft 28.
Specifically, the pedestal control cable 42 is connected to each distal end of the control shaft 28 connected to the pedestal member 10, passes through the cover 4 in the control handle 6, and passes through a control cable operating device (not shown). Pass as a loop.
Thus, activating the control cable actuator pulls the loop of the pedestal control cable 42 closer and pulls the pedestal member 10 closer relative to the distal end 12a against the bias of the spring 34. Those skilled in the art will appreciate that the loop of the pedestal control cable 42 is instead formed as two separate cables or one cable for performing the same operation.
Further, those skilled in the art will appreciate that the base member 10 is connected to the housing 12 by a single shaft 28 if desired. However, such a design may reduce stiffness.

従って、装置の近くからケーブル４２を引き出すために制御ケーブル作動装置を作動し、一方ワーキング・ヘッド・アセンブリ２の位置を常に維持することは、ハウジング１２の遠端１２ａの方へ台部材１０の近くで引き出す。
当業者は軸通路３０、中央通路３２、ガイド軸３０及びスプリング３４の長さは、制御ケーブル４２が最大の間隔に近い状態で引き出され、望んだ組織をステープリングする距離と等しい距離で台部材１０及び遠端１２ａが分離されるまで、遠端１２ａの方へスプリング３４に対して、台部材１０が動かされるように選択されることを理解する。
代わりに、上記のようにこれら要素は、台部材１０及びショルダー部材１２ｃが互いに接触するまで（例えば、装置を挿入及び撤収するために完全に閉止した状態）、遠端１２ａの方へ引き出されるように設計される。
上記したように、この実施形態において、ステープリング位置と完全に閉止した位置は同じである。図２、図３ａ及び図３ｂで示されるように、ショルダー部材１２ｃの厚さが、ステープリングの隙間のサイズを決める。
例えば、約０.０７０インチの隙間が採用される。しかしながら、当業者に理解されるように、（例えば、スプリング止め３６を調節することにより）装置に隣接している分離する隙間を採用することができる。
更に当業者に理解されるように、ユーザは望んだ位置でケーブル４２のロックを可能とし、台部材１０及び遠端１２ａの望んだ幅での分離を保てるようにするために、制御ケーブル作動装置にロック装置（図示せず）を含むことも可能である。 Thus, operating the control cable actuator to pull the cable 42 from near the device, while always maintaining the position of the working head assembly 2, is near the platform member 10 toward the distal end 12a of the housing 12. Pull out with.
Those skilled in the art will appreciate that the length of the shaft passage 30, the center passage 32, the guide shaft 30 and the spring 34 is the same length as the distance that the control cable 42 is pulled out with the maximum spacing and stapling the desired tissue. It will be appreciated that the base member 10 is selected to be moved relative to the spring 34 toward the far end 12a until the 10 and the far end 12a are separated.
Instead, as described above, these elements are pulled toward the distal end 12a until the pedestal member 10 and shoulder member 12c contact each other (eg, fully closed to insert and withdraw the device). Designed to.
As described above, in this embodiment, the stapling position and the fully closed position are the same. As shown in FIGS. 2, 3a and 3b, the thickness of the shoulder member 12c determines the size of the stapling gap.
For example, a gap of about 0.070 inches is employed. However, as will be appreciated by those skilled in the art, a separate gap adjacent to the device can be employed (eg, by adjusting the spring stop 36).
As will be further appreciated by those skilled in the art, the control cable actuator can be used to allow the user to lock the cable 42 in the desired position and to maintain the desired width separation of the platform member 10 and the distal end 12a. It is also possible to include a locking device (not shown).

圧縮スプリング３４は、好ましくはステンレス鋼（例えば、ミュージック・ワイヤー）で形成され、制御ケーブルの作動装置の解放において、台部材１０の、望んだ組織の受け入れを確実にし、例えば、軸２８及び／又はケーブル４２の先端での移動を妨害する任意の抵抗を克服するための十分な偏り力を供給する。
例えば、総合力は約８から１２ポンドであり、より好ましくは約１０ポンドであり、０．７５インチの組織を受け入れるのに十分である。従って、台部材１０が組織ステープリング位置にある時、各スプリング３４は、５ポンドの力がスプリング止め３６と中央通路の遠端の間に適用される位置へ圧縮される。
スプリング３４として用いるのに適切なスプリングは、例えば、市販のLee Spring LC-023-AB-14のような０.１５インチの直径、１.５０インチの自由長さのミュージック・ワイヤー・コイル・スプリングからなる。 The compression spring 34 is preferably formed of stainless steel (eg, music wire) to ensure receipt of the desired tissue of the platform member 10 upon release of the control cable actuator, eg, the shaft 28 and / or Provide sufficient biasing force to overcome any resistance that impedes movement at the tip of cable 42.
For example, the total force is about 8 to 12 pounds, more preferably about 10 pounds, sufficient to accept 0.75 inches of tissue. Thus, when the pedestal member 10 is in the tissue stapling position, each spring 34 is compressed into a position where a 5 pound force is applied between the spring stop 36 and the distal end of the central passage.
A suitable spring for use as the spring 34 is a 0.15 inch diameter, 1.50 inch free length music wire coil spring, such as the commercially available Lee Spring LC-023-AB-14. Consists of.

図４、図５ａ及び図５ｂに示されるように、本発明の第２実施形態のワーキング・ヘッド・アセンブリ２’は、下記の駆動装置を除いて前記実施形態と実質的に類似する。
ワーキング・ヘッド・アセンブリ２’は、該ワーキング・ヘッド・アセンブリの遠端１２ａに、上記図１から図３に対応する軸通路３０内でワーキング・ヘッド・アセンブリ２’に受け入れられる２本の軸２８で接続される台部材１０を含む。
しかしながら、この実施形態において制御ケーブル・ループ４６は、例えばネジ４９で軸２８に接続され、図１から図３に示される上記実施形態の制御ケーブル４２に関連して、覆い４を貫通して制御ケーブル作動装置（図示せず）に延長される。
各制御ケーブル・ループ４６は、下記に詳述するように、ワーキング・ヘッド・アセンブリ２’及び覆い４を制御ケーブル作動装置へ逆に移動させる滑車５２の周りを、ネジ４９から、対応する軸２８を貫通して延長される。
各ケーブル・ループ４６の端部は、対応する軸２８へ接続するために、近接キャップ１４及びケーブル・ルーティング・プレート５１を通過する。 As shown in FIGS. 4, 5 a and 5 b, the working head assembly 2 ′ of the second embodiment of the present invention is substantially similar to the above embodiment except for the following driving device.
The working head assembly 2 'has two shafts 28 that are received by the working head assembly 2' at the distal end 12a of the working head assembly in an axial passage 30 corresponding to FIGS. It includes a base member 10 connected at
However, in this embodiment, the control cable loop 46 is connected to the shaft 28 with, for example, a screw 49 and is controlled through the cover 4 in connection with the control cable 42 of the above embodiment shown in FIGS. It is extended to a cable actuator (not shown).
Each control cable loop 46 extends from a screw 49 to a corresponding shaft 28 around a pulley 52 that moves the working head assembly 2 'and cover 4 back to the control cable actuator, as will be described in detail below. Is extended through.
The end of each cable loop 46 passes through the proximity cap 14 and the cable routing plate 51 for connection to the corresponding shaft 28.

図５ａ及び図５ｂに示されるように、制御ケーブル４６は制御ケーブル作動装置（図示せず）から覆い４を、ワーキング・ヘッド・アセンブリ２’を貫通して延長され、ネジ４９で軸２８に接続される。制御ケーブル４６はネジ４９から軸２８の外側に延長され、ワーキング・ヘッド・アセンブリ２’の外側を通過するために滑車５２の周りを通過し、覆い４から制御ケーブル作動装置へ貫通する。
当業者に理解されるように、制御ケーブル作動装置は、作動装置が操作される時、滑車５２の反対側のケーブル４６の一部分が反対方向に移動するように設計される。各滑車５２はポイントを離れて配され、ケーブル４６は、制御ケーブルが移動する時に軸２８から出て、ケーブル４６はネジ４９及び軸２８を近くへ引き出し、台部材１０はハウジング１２の遠端１２ａに向かい、近くに移動する。
反対方向に制御ケーブル作動装置を操作することは、離れて制御ケーブル４６及び対応するネジ４９を引き出し、軸２８及び台部材１０が遠端１２ａから離れて移動するようにする。 As shown in FIGS. 5 a and 5 b, the control cable 46 extends from the control cable actuator (not shown) through the cover 4, through the working head assembly 2 ′, and is connected to the shaft 28 with screws 49. Is done. The control cable 46 extends from the screw 49 to the outside of the shaft 28, passes around the pulley 52 to pass outside the working head assembly 2 ', and passes from the cover 4 to the control cable actuator.
As will be appreciated by those skilled in the art, the control cable actuator is designed such that a portion of the cable 46 opposite the pulley 52 moves in the opposite direction when the actuator is operated. Each pulley 52 is spaced apart and the cable 46 exits the shaft 28 as the control cable moves, the cable 46 pulls the screw 49 and shaft 28 closer together, and the platform member 10 is the distal end 12a of the housing 12. Go to and move closer.
Operating the control cable actuator in the opposite direction pulls away the control cable 46 and the corresponding screw 49 so that the shaft 28 and the platform member 10 move away from the far end 12a.

図６に示されるように、本発明の第３実施形態のワーキング・ヘッド・アセンブリ２”は、ハウジング１２の遠端１２ａに関連して台部材１０を移動するための駆動装置を除いて前記実施形態に実質的に類似する。
具体的には、ワーキング・ヘッド・アセンブリ２”の駆動装置は、軸方向に柔軟であり、実質的に捩れに対して柔軟性がない駆動軸６０を含み、該駆動軸は孔の開いた遠端６０ａを含み、該遠端は接合糸を第１軸２８’に延長される通路６４に通す。
第１軸２８’は、ヨーク部材で第２軸２８”に接続される。第１軸２８’は、ハウジング１２に関連する回転が、例えば、それぞれ軸通路３０に切り欠けが適合する軸２８’の突起により妨げられる。
従って、駆動軸６０が第１軸２８’に関連する第１方向において回転するにつれ、第１軸２８’、ヨーク部材６６及び第２軸２８”はハウジング１２へ離れて進み、台部材１０は、遠端１２ａから離れて移動する。
駆動軸６０が第１方向とは反対の第２方向に回転する時、第１軸２８’、ヨーク部材６６及び第２軸２８”は、ハウジング１２の近くに引き出され、台部材１０は遠端１２ａの方向に引き寄せられる。 As shown in FIG. 6, the working head assembly 2 ″ of the third embodiment of the present invention is the same as that described above except for the driving device for moving the base member 10 in relation to the distal end 12a of the housing 12. Substantially similar in form.
In particular, the drive device of the working head assembly 2 ″ includes a drive shaft 60 that is axially flexible and substantially inflexible to torsion, the drive shaft being a perforated far end. Including the end 60a, the far end passes the joining thread through a passage 64 that extends to the first shaft 28 '.
The first shaft 28 ′ is connected to the second shaft 28 ″ with a yoke member. The first shaft 28 ′ is a shaft 28 ′ in which the rotation associated with the housing 12 is fitted, for example, with a notch in the shaft passage 30, respectively. It is obstructed by the protrusions.
Thus, as the drive shaft 60 rotates in the first direction relative to the first shaft 28 ', the first shaft 28', the yoke member 66 and the second shaft 28 "move away to the housing 12, and the platform member 10 is Move away from the far end 12a.
When the drive shaft 60 rotates in the second direction opposite to the first direction, the first shaft 28 ′, the yoke member 66 and the second shaft 28 ″ are pulled out near the housing 12, and the base member 10 is at the far end. It is drawn in the direction of 12a.

図７は、本発明の駆動装置の第４実施形態を示し、該実施形態はハウジング１２の遠端１２ａに関連する台部材１０を移動するための駆動装置を除いて前記実施形態に実質的に類似する。図７の駆動装置は、例えば、取り付けられるネジ部材（図示せず）を有する駆動軸６０を含む。
ネジ部材は、共に回転するためのアイドラー・ギア７２内に受け入れられる。アイドラー・ギア７２は軸７６を回転するためにギア７４と噛み合わせる。各軸７６は、ネジが形成された端部７６ａを含み、該端部は軸２８の通路内で結合される（上記した、軸２８’とネジ部６０ａのように）。
従って、駆動軸６０の回転の際に、アイドラー・ギア７２は、軸２８及び台部材１０をハウジング１２の遠端１２ａに向けて行き来するためにギア７４、軸７６及びスレッド部７６ａを回転する。 FIG. 7 shows a fourth embodiment of the drive device of the present invention, which embodiment is substantially similar to the previous embodiment except for the drive device for moving the base member 10 associated with the distal end 12 a of the housing 12. Similar. The drive device of FIG. 7 includes, for example, a drive shaft 60 having a screw member (not shown) to be attached.
The screw member is received in an idler gear 72 for rotation together. Idler gear 72 meshes with gear 74 to rotate shaft 76. Each shaft 76 includes a threaded end 76a that is coupled within the passage of shaft 28 (as described above for shaft 28 'and threaded portion 60a).
Accordingly, when the drive shaft 60 rotates, the idler gear 72 rotates the gear 74, the shaft 76, and the sled portion 76a to move the shaft 28 and the base member 10 back and forth toward the far end 12a of the housing 12.

図８は、本発明の駆動装置の第５実施形態を示し、該実施形態はハウジング１２の遠端１２ａに関連する台部材１０を移動するための駆動装置を除いて前記実施形態に実質的に類似する。図８の駆動装置は、例えば、取り付けられるネジ部材（図示せず）を有する駆動軸６０を含む。ネジ部材は、共に回転するための第１ギア８０内に受け入れられる。
第１ギア８０は第２ギア８４を回転するためにアイドラー・ギア８２と噛み合わせられる。第１ギア８０及び第２ギア８４の回転は対応する、取り付けられている軸８６の内の１本を順番に回転する。各軸８６は、ネジが形成された端部８６ａを含み、該端部は対応する軸２８の内の１本の通路内で結合される（上記した、軸２８と軸７４のように）。
従って、駆動軸６０の回転において、ネジ部材はギア８０を回転し、その結果、アイドラー・ギア８２及び第２ギア８４を回転し、台部材１０を遠端１２ａ方に行き来するため、該回転は軸２８内で軸８６及びネジ部８６ａを回転する。 FIG. 8 shows a fifth embodiment of the drive device of the present invention, which embodiment is substantially similar to the previous embodiment except for the drive device for moving the base member 10 associated with the distal end 12a of the housing 12. FIG. Similar. 8 includes, for example, a drive shaft 60 having a screw member (not shown) to be attached. The screw member is received in a first gear 80 for rotation together.
The first gear 80 meshes with the idler gear 82 to rotate the second gear 84. The rotation of the first gear 80 and the second gear 84 rotates one of the corresponding attached shafts 86 in turn. Each shaft 86 includes a threaded end 86a that is coupled within a passage in the corresponding shaft 28 (as described above for shaft 28 and shaft 74).
Accordingly, in the rotation of the drive shaft 60, the screw member rotates the gear 80. As a result, the idler gear 82 and the second gear 84 are rotated, and the base member 10 is moved back and forth toward the far end 12a. The shaft 86 and the screw portion 86a are rotated within the shaft 28.

上記実施形態は、例示のみを目的としており、今後明らかとなるこれら実施形態の様々な修正は、本発明の技術の範囲内であり、本発明は請求項よってのみ制限される。   The above embodiments are for illustrative purposes only, and various modifications of these embodiments which will become apparent in the future are within the scope of the present invention, and the present invention is limited only by the claims.

本発明の第１実施形態の全層切除装置の斜視図を示す。The perspective view of the full-thickness excision apparatus of 1st Embodiment of this invention is shown. 図１の装置のワーキング・ヘッド・アセンブリの斜視図を示す。Figure 2 shows a perspective view of the working head assembly of the apparatus of Figure 1; 台部材が閉止位置にある図２のワーキング・ヘッド・アセンブリの断面図を示す。FIG. 3 shows a cross-sectional view of the working head assembly of FIG. 2 with the platform member in the closed position. 台部材が開き、組織を受け入れる位置にある、図２のワーキング・ヘッド・アセンブリの断面図を示す。FIG. 3 illustrates a cross-sectional view of the working head assembly of FIG. 2 with the pedestal member open and receiving tissue. 図３ａ及び図３ｂの取付軸の側面図を示す。Fig. 4 shows a side view of the mounting shaft of Figs. 3a and 3b. ハウジングの停止面をより詳細に示す、図３ａ及び図３ｂのワーキング・ヘッド・アセンブリの断面図の一部分を示す。Fig. 4 shows a portion of a cross-sectional view of the working head assembly of Figs. 本発明の第２実施形態の全層切除装置の斜視図を示す。The perspective view of the full-thickness excision apparatus of 2nd Embodiment of this invention is shown. 台部材が閉止位置にある図４のワーキング・ヘッド・アセンブリの断面図を示す。FIG. 5 shows a cross-sectional view of the working head assembly of FIG. 4 with the platform member in the closed position. 台部材が開き、組織を受け入れる位置にある、図４のワーキング・ヘッド・アセンブリの断面図を示す。FIG. 5 shows a cross-sectional view of the working head assembly of FIG. 4 with the pedestal member open and receiving tissue. 本発明の第３実施形態の全層切除装置の斜視図を示す。The perspective view of the full layer cutting device of 3rd Embodiment of this invention is shown. 本発明の第４実施形態の駆動装置の一部を示す。A part of drive device of a 4th embodiment of the present invention is shown. 本発明の第５実施形態の駆動装置の一部を示す。The drive device of 5th Embodiment of this invention is shown.

Claims (8)

患者のボディ・ルーメン内で作動位置にある時、制御ハンドルが患者の体外にある作動装置を含む制御ハンドルと、
装置が作動位置にある時、治療される組織部位に隣接する患者のボディ・ルーメン内に配され、覆いを介して作動装置から第１組織ステープリング部材へ延長される第１トランスミッション部材に関連して互いが移動可能である第１及び第２組織ステープリング部材を含み、柔軟な覆いで制御ハンドルと接続されるワーキング・ヘッド・アセンブリと、
前記柔軟な覆いを貫通して作動装置から前記第１組織ステープリング部材へ延長され、作動装置が前記覆いから第１ケーブルを近くに引き出すため作動する時、第１組織ステープリング部材が、第２組織ステープリング部材に関連して第１方向へ移動するようにする第１ケーブルと、
第１組織ステープリング部材から制御ハンドルへ延長される第２ケーブルであって、前記覆いから近くに引き出される時、前記第１方向の反対の第２方向において、第１組織ステープリング部材が第２組織ステープリング部材に対して移動する第２ケーブルとを備える外科用装置。A control handle including an actuating device when the control handle is outside the patient's body when in the operating position within the patient's body lumen;
Associated with a first transmission member disposed in the patient's body lumen adjacent to the tissue site to be treated and extending from the actuator to the first tissue stapling member through a covering when the device is in the activated position. A working head assembly including first and second tissue stapling members movable relative to each other and connected to the control handle with a flexible covering;
The first tissue stapling member is extended through the flexible covering from the actuating device to the first tissue stapling member and when the actuating device is activated to draw the first cable from the covering close to the first tissue stapling member. A first cable adapted to move in a first direction relative to the tissue stapling member;
A second cable extending from the first tissue stapling member to the control handle, wherein the first tissue stapling member is second in a second direction opposite the first direction when pulled proximally from the covering. surgical apparatus Ru and a second cable to move relative to the tissue stapling member. 力が第１ケーブルに適用されない時、第１組織ステープリング部材が第２組織ステープリング部材に関連して第２方向に動かされるように、前記第１方向の反対の第２方向に第２組織ステープリング部材に関連して前記第１組織ステープリング部材を動かす弾性部材から更になる請求項１の装置。When a force is not applied to the first cable, the second tissue in a second direction opposite the first direction so that the first tissue stapling member is moved in the second direction relative to the second tissue stapling member. The apparatus of claim 1, further comprising an elastic member that moves the first tissue stapling member relative to the stapling member. 第１組織ステープリング部材が台部材であり、第２組織ステープリング部材がステープル発射装置である請求項２の装置。The apparatus of claim 2 , wherein the first tissue stapling member is a pedestal member and the second tissue stapling member is a staple firing device. 前記台がスライド可能なようにワーキング・ヘッド・アセンブリに接続される軸に取り付けられ、弾性部材が軸と前記ワーキング・ヘッド・アセンブリの間で接続されるバネであることを特徴とする請求項３の装置。Claim 3 wherein the platform is attached to a shaft which is connected to the working head assembly to allow the slide, the resilient member being a spring connected between said working head assembly and axial Equipment. 前記第１組織ステープリング部材が台であり、前記第２組織ステープリング部材がステープル発射装置であり、前記第２ケーブルが前記台に接続するために滑車の周りを延長され、前記第２ケーブルが覆いの近くに引き出される時、前記台はステープル発射装置と相対的に離れて動かされる、請求項１の装置。The first tissue stapling member is a pedestal, the second tissue stapling member is a staple firing device, the second cable is extended around a pulley to connect to the pedestal, and the second cable is when drawn near the cover, it said platform is moved away relative to the staple firing system, apparatus according to claim 1. 前記台がワーキング・ヘッド・アセンブリにスライド可能なように軸に取り付けられ、第２ケーブルが軸に接続されることを特徴とする請求項５の装置。6. The apparatus of claim 5 , wherein the platform is slidably mounted on the shaft to the working head assembly and a second cable is connected to the shaft. ワーキング・ヘッド・アセンブリ内で、前記台が軸にスライド可能なように受け入れられて接続され、前記第１ケーブルが軸の遠端から覆いを貫通し作動装置へ延長され、覆いから近くへの第１ケーブルの引き出しは、ステープル発射装置と相対的に、台を近くに引き出すようにすることを特徴とする請求項５の装置。Within the working head assembly, the platform is slidably received and connected to the shaft, and the first cable extends from the distal end of the shaft through the cover to the actuator, and the first cable from the cover to the vicinity. 6. The apparatus of claim 5 , wherein the pulling of one cable causes the platform to be pulled closer relative to the staple firing device. 操作者が第１及び第２組織ステープリング部材を、互いが望ましい位置においてロックすることを可能とする制御ハンドルのロッキング部材から更になる請求項１の装置。The apparatus of claim 1, further comprising a locking member of the control handle that allows an operator to lock the first and second tissue stapling members in a desired position relative to each other.
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CA2454160C (en) 2010-04-13
WO2003099138A3 (en) 2004-01-29
EP1404229A2 (en) 2004-04-07
US6685079B2 (en) 2004-02-03
US20040118896A1 (en) 2004-06-24
DE60317984D1 (en) 2008-01-24
US6938814B2 (en) 2005-09-06
US20030218047A1 (en) 2003-11-27
EP1404229B1 (en) 2007-12-12
US20050263561A1 (en) 2005-12-01
WO2003099138A2 (en) 2003-12-04
DE60317984T2 (en) 2008-12-11
US7559451B2 (en) 2009-07-14
AU2003234288B2 (en) 2008-12-18
CA2454160A1 (en) 2003-12-04
AU2003234288A1 (en) 2003-12-12
JP2005526568A (en) 2005-09-08
ATE380503T1 (en) 2007-12-15

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